Evaluation of a multischool collaborative COVID-19 vaccination project.

To describe experiences of student nurses and faculty who participated in COVID-19 vaccine delivery through a multischool collaboration. Cross-sectional survey. Student nurses and faculty members from five university schools and colleges of nursing who participated in one or more COVID-19 vaccination or education events in 2021. Surveys were designed for students and faculty to document process and outcome experiences associated with project participation. Surveys were administered through an online survey platform. Overall, 648 students and 68 faculty members participated in the project. The evaluation survey was completed by 115 students (18%) and 58 faculty members (85%). Students valued increasing their clinical skills and reported the experience influenced their perspectives on nursing, fueling their passion and informing future career choices. Students reported that it was personally important to contribute to the vaccination effort. Few students reported challenges in participating in the project. Faculty reported positive experiences including gaining knowledge about public health and their communities, fueling their passion for nursing education, feeling a deeper connection with students, and experiencing personal satisfaction from contributing to the pandemic response. This project resulted in meaningful student learning opportunities, enhanced capacity for the public health emergency response, and strengthened partnerships among nursing programs and between academia and public health community partners.

A critical gap: Advanced practice nurses focused on the public's health.

BACKGROUND: The COVID-19 pandemic has highlighted the need for nurse leaders who "embrace the interconnection" between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce. PURPOSE: We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health. DISCUSSION: We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.

Forecasting the Revenues of Local Public Health Departments in the Shadows of the "Great Recession".

CONTEXT: The ability of local health departments (LHD) to provide core public health services depends on a reliable stream of revenue from federal, state, and local governments. This study investigates the impact of the "Great Recession" on major sources of LHD revenues and develops a fiscal forecasting model to predict revenues to LHDs in one state over the period 2012 to 2014. Economic forecasting offers a new financial planning tool for LHD administrators and local government policy makers. This study represents a novel research application for these econometric methods. METHODS: Detailed data on revenues by source for each LHD in Wisconsin were taken from annual surveys conducted by the Wisconsin Department of Health Services over an 8-year period (2002-2009). A forecasting strategy appropriate for each revenue source was developed resulting in "base case" estimates. An analysis of the sensitivity of these revenue forecasts to a set of alternative fiscal policies by the federal, state, and local governments was carried out. FINDINGS: The model forecasts total LHD revenues in 2012 of $170.5 million (in 2010 dollars). By 2014, inflation-adjusted revenues will decline by $8 million, a reduction of 4.7%. Because of population growth, per capita real revenues of LHDs are forecast to decline by 6.6% between 2012 and 2014. There is a great deal of uncertainty about the future of federal funding in support of local public health. A doubling of the reductions in federal grants scheduled under current law would result in an additional $4.4 million decline in LHD revenues in 2014. CONCLUSIONS: The impact of the Great Recession continues to haunt LHDs. Multiyear revenue forecasting offers a new financial tool to help LHDs better plan for an environment of declining resources. New revenue sources are needed if sharp drops in public health service delivery are to be avoided.

Assuring a strong foundation for our nation's public health systems.

BACKGROUND: A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them. PURPOSE: This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health. DISCUSSION: National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession. CONCLUSION: We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.

Updating the definition and role of public health nursing to advance and guide the specialty.

National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty--The Definition and Role of Public Health Nursing--has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one-sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population-focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings.

The mobilizing action toward community health partnership study: multisector partnerships in US counties with improving health metrics.

INTRODUCTION: Multisector partnerships are promoted as a mechanism to improve population health. This study explored the types and salient features of multisector partnerships in US counties with improving population health metrics. METHODS: We used the "Framework for Understanding Cross-Sector Collaborations" proposed by Bryson, Crosby, and Stone to guide data collection and interpretation. Comparative case studies were conducted in 4 counties selected on the basis of population, geographic region, an age-adjusted mortality decline better than the US average, and stable per capita income. Data were collected through website and report reviews and through in-depth interviews with key informants (N = 59) representing multiple sectors. County reports were developed and cross-case themes related to partnership types and salient features were derived. RESULTS: Multisector collaboration was common in all 4 counties despite substantial variations in population, geographic size, demographic diversity, and other characteristics. Most partnerships were formed by professionals and organizations to improve delivery of health and social services to vulnerable populations or to generate policy, system, and environment changes. Multisector collaboration was valued in all cases. Outcomes attributed to partnerships included short- and long-term effects that contributed to improved population health. CONCLUSION: The Bryson, Crosby, and Stone model is a useful framework for conducting case study research on multisector partnerships. Outcomes attributed to the multisector partnerships have the potential to contribute to improvement in population health. Further study is needed to confirm whether multisector partnerships are necessary for improving population health within counties and to understand which partnership characteristics are critical for success.

Strategies for academic nursing to advance global and planetary health: A call to action.

Nurses play a crucial role in addressing human health influenced by global forces such as pandemics, and political conflicts that displace millions; in leading efforts to promote planetary health; and in achieving the United Nations (UN) Sustainable Development Agenda. Academic nursing programs have a significant role in actualizing nursing's impact on global health (GH) and planetary health (PH). This paper describes how nursing programs can actualize their GH and PH nursing perspectives to benefit students and society, thereby increasing nursing's effectiveness and improving health outcomes in local and global settings. Numerous strategies to actualize GH and PH perspectives were derived from current literature and an assessment of eleven nursing program websites. Nursing programs may adopt program-wide strategies such as reflecting GH and PH in their mission statement; through education, in courses; and through faculty or student scholarship, policy endeavors, and/or partnerships. Now is the time to take such action, recommitting to GH and PH nursing and deepening nursing's impact. Academic nursing programs' leadership role in society, and their role in preparing nurses to lead, educate, discover, and advocate is essential for the health of populations and the planet long into the future.

Interest in public health careers among undergraduate student nurses.

CONTEXT: Public health workforce trends demonstrate threats to a vital national resource. The current shortage of public health nurses is due to a variety of factors. One route to addressing the public health nursing shortage is to increase the level of interest in public health as a career option for nurses. OBJECTIVE: The main objective of this study was to examine the relationship of nursing education program and field experience characteristics on the level of interest in a public health career among student nurses. DESIGN: Cross-sectional, online surveys of undergraduate student nurses were conducted over 6 semesters to assess the relationship of field practicum characteristics and level of interest in a public health career. SETTING: Undergraduate student nurses (N = 882) enrolled in traditional baccalaureate nursing programs (n = 18) and online associate to baccalaureate degree completion programs (n = 2) in one US state participated in the survey after completing the required community or public health coursework and field experiences. MAIN OUTCOME MEASURE: Level of interest in a career in public health was measured using a 4-point Likert-type scale anchored by "no interest" and "very strong interest." RESULTS: Overall, 46% of respondents expressed either moderate or strong interest in a future career in public health. Having had a field experience in a local health department was the only type of experience associated with stronger interest in a public health career. Enrollment in baccalaureate completion programs was associated with higher interest, and enrollment in programs located in a region of the state where students were significantly less likely to have field experiences in local health departments was associated with lower interest. CONCLUSION: Career interests for nurses are developed in part through field experiences while in nursing school. Interest in public health careers may be nurtured through field experiences in local health departments.

The impact of Web-delivered education on preceptor role self-efficacy and knowledge in public health nurses.

OBJECTIVE: Preceptors are an essential component in preparing student nurses to become practicing public health nurses. Preparation for the preceptor role is important for achieving a quality learning experience for students. This study was conducted to explore the relationship between completion of a Web-delivered preceptor education program and both knowledge of the preceptor role and self-efficacy to perform in the preceptor role. DESIGN AND SAMPLE: This study used a pretest-posttest, quasi-experimental design. The participants were experienced public health nurses (n=31) working in one state in the United States. MEASURES: Pretest and posttest Web-delivered survey using the preceptor self-efficacy questionnaire and an instrument assessing knowledge gain. INTERVENTION: A Web-delivered preceptor education program tailored for public health nurses. RESULTS: The program was associated with improved self-efficacy scores at both the immediate and the 3-month posttest, and with increased knowledge of the preceptor role evident at the immediate posttest only. Self-efficacy scores were independent of knowledge scores. Preceptor age was not correlated with self-efficacy or knowledge scores. Nurses with higher levels of education demonstrated higher self-efficacy scores in all 3 measurements. CONCLUSIONS: Web-delivered continuing education targeted to public health nurse preceptors is an effective method to increase confidence and knowledge for the preceptor role.

Multisector partnerships in population health improvement.

Many new initiatives for population health improvement feature partnerships of leaders and organizations across multiple sectors of society. The purpose of this article is to review 1) the rationale for such partnerships as an important, if not essential, tool for population health improvement; 2) key organizational and contextual factors that appear to be associated with effective multisector partnerships; and 3) the limited evidence regarding the effect of such partnerships on population health outcomes. We conclude that systems thinking - accounting for the collective effect of many actors and actions - is essential to organizing and sustaining efforts to improve population health, and to evaluating them. More research is needed to understand how and why multisector partnerships are formed and sustained and the conditions under which multisector partnerships are necessary or more effective than other strategies for population health improvement. Research on and evaluation of multisector partnerships also need to incorporate more standard measures of partnership contexts, characteristics, and strategies and adopt longitudinal and prospective designs to accelerate social learning in this area. Finally, studies of multisector partnerships must be alert to the value of such initiatives to individuals and communities apart from any direct and measurable impact on population health.

Providers' experiences with young people's cognitive representations and emotions related to the prevention and treatment of sexually transmitted infections.

OBJECTIVE: The Common Sense Model (CSM) was used as the organizing framework to examine providers' experiences with young people's cognitive representations and emotions related to the prevention and treatment of sexually transmitted infections (STIs). This study was conducted to develop insights into potential avenues for enhancing the effectiveness of STI education and counseling for young people. DESIGN: This was a qualitative investigation using semi-structured focus group interviews. SAMPLE: The 5 focus groups were comprised of 30 providers of STI education and counseling: public health nurses, peer educators, and nurse practitioners. MEASUREMENT: Content of transcribed focus group interviews was coded using a predetermined coding scheme based on the five dimensions of representational beliefs and emotions defined by the CSM. RESULTS: The providers identified that young people hold a number of STI misconceptions within each dimensions of the CSM. Anger and embarrassment about STIs are common emotions experienced by young people. CONCLUSIONS: This investigation suggests that providers are able to elicit and identify STI-related misconceptions held by young people, and that the CSM model is a useful classification method. Identifying misconceptions could be useful in developing tailored STI education and counseling interventions by public health nurses.

Supporting nurse preceptors through online continuing education.

BACKGROUND: A pilot study was conducted to assess the feasibility of using an online continuing education course to increase knowledge and self-efficacy in nurse preceptors who work with student nurses in acute and primary care settings. METHODS: A one-group pre- and posttest repeated measures design was used. Pre-course knowledge and self-efficacy were assessed with an electronic survey. Post-course knowledge and satisfaction assessments were embedded in the course. Knowledge retention and change in self-efficacy were assessed with an electronic follow-up survey. Analysis used paired sample t tests. RESULTS: Participants (N = 13) reported satisfaction with the course. Participant knowledge increased from pretest to post-course and from pretest to follow-up. Knowledge declined from post-course to follow-up. No change in self-efficacy ratings was observed. CONCLUSION: This study suggests that online continuing education is a feasible strategy to support preceptor learning. Further research on the effectiveness of this approach in changing and retaining knowledge and improving self-efficacy is needed.

Meningococcal serogroup B outbreak response University of Wisconsin-Madison.

A meningococcal serogroup B (MenB) outbreak at a large public university prompted an emergency response to immunize undergraduates. OBJECTIVE: To report on a successful meningococcal serogroup B (MenB) vaccine clinic response at a large public university. METHODS: We assembled the team leaders to write this case report. RESULTS: Activation of the emergency plan and points of dispensing required cooperation of many units on campus under the leadership of university health officials with support from Centers for Disease Control and Prevention, state division of public health and the city-county health department. Significant efforts to provide consistent messages to students and parents regarding the outbreak and the availability of the MenB vaccines were made. Volunteers were recruited to staff the clinics alongside university healthcare providers. Over 22,000 doses of vaccine were administered. CONCLUSION: We report our experience and lessons learned which may be helpful to universities in preventing and responding to disease outbreaks.

Local public health department funding: trends over time and relationship to health outcomes.

BACKGROUND: Local health departments contribute to population health improvement through the core functions of assessment, policy development, and assurance. Their capacity to perform these functions may be affected by funding and staffing. OBJECTIVE: To describe local health department funding and staffing levels and determine the relationship between these measures and county-level health outcomes. METHODS: Ten years of total funding, funding by revenue source, and staffing data from local health departments in all 72 Wisconsin counties were collected from the Department of Health and Family Services and analyzed. Summary measures for county health outcomes were obtained from the 2006 Wisconsin County Health Rankings, and a correlation matrix was created to determine associations between outcomes and measures of health department capacity. RESULTS: On average, Wisconsin local health departments spend $20.60 per capita, ranging from $7.50 to $68.30 among counties. While total per capita funding in the state (adjusted for inflation) increased $0.82 per year, a closer look reveals 3 distinct periods: increases of $0.20 per year during 1995-1997 and $1.33 per year during 1997-2001; but a decrease of $0.27 during 2001-2004. Local health departments in counties with worse health outcomes had only slightly higher average funding and staffing levels during 2002-2004. CONCLUSION: Levels of health department funding in Wisconsin, already low by US standards, declined slightly in the past 3 years. Although counties with the worst health outcomes had slightly higher levels of public health funding, considerable disparities exist. State policymakers might consider investing more resources in counties with the greatest need, to support evidence-based public health programs and reduce existing geographic health disparities in Wisconsin.

The road to population health: using Healthy People 2010 in nursing education.

Healthy People 2010: Understanding and Improving Health and corresponding state health improvement plans provide roadmaps for planning, monitoring, and evaluating population health improvement in the United States. These documents offer relevant guidance for nursing education because they address health workforce education specifically, use a population perspective, and include evidence-based action priorities. However, information about how these documents are used in nursing education is limited. This article discusses the relevance of national and state health planning documents for nursing education. Nurse educators are encouraged to reflect on the alignment of current nursing education efforts with national and state health planning agendas. Suggestions for future use of national and state population health improvement planning documents in guiding strategic, curricular, and course planning are offered.

Local public health system partnerships.

OBJECTIVES: Interorganizational collaboration aimed at community health improvement is an expectation of local public health systems. This study assessed the extent to which such collaboration occurred within one state (Wisconsin), described the characteristics of existing partnerships, and identified factors associated with partnership effectiveness. METHODS: In Stage 1, local health department (LHD) directors in Wisconsin were surveyed (93% response rate). In Stage 2, LHDs completed self-administered mailed surveys for each partnership identified in Stage 1 (85% response rate). Two-level hierarchical logit regression methods were used to model relationships between partnership and LHD variables and partnership outcomes. Data from 924 partnerships associated with 74 LHDs were included in the analysis. RESULTS: Partnerships most frequently addressed tobacco prevention and control, maternal and child health, emergency planning, community assessment and planning, and immunizations. Partnering was most frequent with other government agencies, hospitals, medical practices or clinics, community-based organizations, and schools. Partnership effectiveness was predicted by having a budget, having more partners contributing financially, having a broader array of organizations involved, and having been in existence for a longer period of time. A government mandate to start the partnership was inversely related to successful outcomes. Characteristics of LHDs did not predict partnership effectiveness. CONCLUSIONS: Financial support, having a broader array of partners, and allowing sufficient time for partnerships to succeed contribute to partnership effectiveness. Further study-using objective outcome measures-is needed to examine the effects of organizational and community characteristics on the effectiveness of local public health system partnerships.

Public health practice competency improvement among nurses.

BACKGROUND: Recommendations for improving public health workforce competency led to an academic-practice partnership project conducted to improve competency for providing essential public health services among public health nurses. PURPOSE: To measure competency for public health practice at baseline, identify factors associated with higher competency, document change in competency over 4 years, and assess differential effects associated with project participation. METHODS: Perceived competency was assessed using a validated instrument administered through online surveys at baseline (2007) and 4-year follow-up (2011). Analysis was completed in 2014. Overall means and SDs were calculated for each domain in the competency scale. Differences in means by role were tested using multivariate analysis of variance. Factors associated with higher competency were identified using regression analysis. Mean comparisons between baseline and follow-up were tested using paired samples t test and ANCOVA was used to test differential effects of project participation. RESULTS: Baseline competency levels were low in most domains. Managers reported higher competency in all domains compared to staff. Mean scores in all domains were higher on follow-up than baseline. Factors associated with higher competency in some domains included expected frequency of performance, higher degree, and younger age. Participants in project activities had higher mean competency scores than those who did not, with statistically significant differences (p<0.05) observed in four of nine domains. CONCLUSIONS: Participation in workforce development can contribute to improved perceived competency for public health practice among nurses. Continued investment in workforce development aimed at improving competency and additional research on competency assessment is warranted.

PUBLIC HEALTH NURSING IN MISSISSIPPI: CHANGES IN CONTEXT AND PRACTICE.

Current standards and competencies guiding public health nursing (PHN) practice promote population-focused practice, but few studies have examined the extent to which change toward this type of practice has occurred. A cross-sectional, mail-back survey was conducted among public health nurses in Mississippi to examine recent changes in their practice, contextual factors related to population-focused practice, and recommendations for improving practice and educational preparation for practice. The survey response rate was 54% (n=150 [of 277]). Participants were predominantly female (95%), White (85%), 46 years or older (62%) and held an associate degree in nursing (69%). Most experienced nurses (n=106, 70%) reported perceived practice changes compared to five years prior, but did not consistently report changes toward greater population-focused practice. Participants reported funding decreases and negative effects on practice stemming from the nursing shortage. Recommendations for improving practice conditions included increasing resources, improving workplace environment and management practices, changing the focus of services, and promoting awareness of public health and PHN. Recommendations for improving education included providing more clinical experiences in public health settings and increasing financial supports and distance learning options. Additional research is needed to determine the nature and characteristics of population-focused PHN as practiced in Mississippi and elsewhere.

Partnerships for learning population-based public health nursing: Web-delivered continuing education for public health nurse preceptors.

Public health and other community health nurses frequently serve as preceptors to undergraduate student nurses learning population-based nursing in community/public health practicum courses. The extent of preparation and support for the preceptor role provided by schools of nursing is often limited. One strategy to address this problem is to provide targeted, Web-delivered continuing education (CE) to preceptors. A Web-delivered CE course entitled, "Partnerships for Learning Community Health Nursing," was created and pilot tested. Course content includes preceptor roles; assisting students in learning population-based public health nursing, critical thinking, and cultural competence; learning styles and teaching strategies; what to do in challenging situations; evaluation and feedback; and specific information about school policies, procedures, and course assignments. Precourse knowledge was assessed using a mailed survey. Postcourse knowledge and satisfaction were assessed using questions embedded in the course. Postsemester knowledge and satisfaction were evaluated through a postsemester survey. Knowledge gain was tested using repeated measures ANOVA and paired t tests. Thirteen preceptors participated in the pilot test. Repeated measures ANOVA indicated that knowledge gain occurred (multivariate F=55.603, df=2, error df=11, p<.0001). Participants increased knowledge from pretest to posttest (t=-10.25, p<.00001) and from pretest to end of the semester (t=-4.95, p<.0003). Knowledge decline from end of course to end of semester was not significant (t=1.94, p=.08). Participants reported satisfaction with the course. Web-delivered CE for community/public health nurse preceptors can support preceptor learning and is an acceptable method for receiving this type of education. Further research is needed on the impact of preceptor education on student learning.

Local partnerships for community assessment and planning.

PURPOSE: Community assessment is a core function of public health. National and state policies encourage local health departments (LHDs) to engage local partners in conducting community assessments. This study examined the prevalence, characteristics, and effectiveness of community assessment partnerships between LHDs and other organizations. METHODS: LHDs in Wisconsin completed a 2-stage, cross-sectional survey. A subset analysis of community assessment partnerships was conducted using descriptive, bivariate, and multivariate statistical methods. RESULTS: Ninety percent of LHDs reported a partnership focused on community assessment (n = 69). Sixty-six percent of community assessment partnerships had existed for three or more years, and all of these had implemented plans (n = 43). Community assessment partnerships were more likely than partnerships focused on other issues to have formed because of a mandate, to include many partners, and to receive some forms of financial support from the LHD. Partnerships focused on community assessment were no more likely to be effective than other types of partnerships. CONCLUSIONS: LHDs and community partners realize mutual benefits from collaborating on community assessment. Successful community assessment partnerships can be supported by building competencies in the public health workforce and sustaining partnerships for substantial periods of time.